- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,054.50 / $2,693.50 / $7,469.50
| Facility | | $1,054.50 | $2,693.50 | $7,469.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $224.97 / $878.57 / $1,233.74
| Professional | | $224.97 | $878.57 | $1,233.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $574.56 / $1,097.41 / $12,706.70
| Facility | | $574.56 | $1,097.41 | $12,706.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,081.04 / $1,945.87 / $9,033.17
| Facility | | $1,081.04 | $1,945.87 | $9,033.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $77.09 / $79.00 / $91.00
| Facility | | $77.09 | $79.00 | $91.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $655.93 / $676.01 / $757.50
| Professional | | $655.93 | $676.01 | $757.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $167.06 / $167.06 / $167.06
| Professional | | $167.06 | $167.06 | $167.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $422.21 / $491.09 / $751.65
| Professional | | $422.21 | $491.09 | $751.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $205.80 / $294.00 / $604.38
| Professional | | $205.80 | $294.00 | $604.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,613.67 / $1,613.67 / $1,613.67
| Facility | | $1,613.67 | $1,613.67 | $1,613.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,927.06 / $5,862.59 / $6,676.80
| Professional | | $1,927.06 | $5,862.59 | $6,676.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,185.00 / $3,269.00 / $7,384.00
| Facility | | $1,185.00 | $3,269.00 | $7,384.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.04 / $1,666.80 / $2,581.44
| Professional | | $1,047.04 | $1,666.80 | $2,581.44 |